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TENS stimulation for WED/RLS: Effective parameters

Posted: Wed Oct 16, 2013 12:09 pm
by LucyBrown
Current effective TENS placements and parameters documented for two people with RLS (idiopathic, one for approx. 30 yrs, one for approx 3 yrs; mild to moderate symptoms): location, location, location, it's important for a house and for a TENS electrode. 1) On the back of the legs, between the knee and the hip joints, over the hamstring muscle, which can be found by bending the knee and feeling for the tight muscle. Pulse width: 180 microseconds. The frequency (rate) of the pulses: 10 per second. The intensity: just so you feel a tingling. The feeling of the tingling can go away after a few minutes. Duration of stimulation: from one hour to the whole night. Continuous stimulation or modulated (changes from greater to lesser intensity over seconds). If the stimulator is turned off and symptoms awaken you, turn it on again. 2) on the wrist, about one inch from the crease between the hand and the arm (see image attached)[img]
WristLocation.jpg
[/img]. Electrodes should be small and placed across the wrist. Pulse width: 180 microseconds. The frequency (rate) of the pulses: 10 per second. The intensity: just so you feel a tingling in the palm and middle finger(s). Continuous stimulation DOES NOT work. It needs to be 2 seconds on/ one second off, or in the modulation mode. Duration of stimulation: about two hours a day; one hour during the day, one hour before going to sleep. A wrist stimulator for motion sickness is most effective on the wrist.
Warnings: don't use a TENS stimulator if you have a heart condition or pacemaker without consulting a doctor. The leg stimulation might increase calf muscle cramps. Advantages: sensory "discomfort" in the legs and need to move disappear (for two people documented so far-- in one person, for years, in another for two months); fewer and shorter times awake during the night than baseline. Drug needs reduced or eliminated. Improved daytime functioning and feeling.
Importantly, there is a scientific rationale for TENS to affect WED/RLS .

Re: TENS stimulation for WED/RLS: Effective parameters

Posted: Wed Oct 16, 2013 7:00 pm
by Polar Bear
Thank you for this :)
A super instruction.

Re: TENS stimulation for WED/RLS: Effective parameters

Posted: Thu Oct 30, 2014 4:50 am
by fixrls
I am a new member. I developed symptoms suddenly after kidney stone treatment under anaesthesia about 4 years ago. (I think it was the anaesthesia that caused the onset). I have managed my WED without medication, because I don't want to deal with the side effects. What works for me is daily walks of over an hour, keeping my weight down, and early,
small meals. Recently my workload has increased, keeping me from daily exercise, and symptoms have increased. I am a physical therapist and have a TENS unit, so I have been experimenting with electrode placement and intensity. I place the active electrode of one channel on each calf (largest muscle belly) and the inactive electrode on the front of my legs. It seems low intensity of a slow pulsed current shuts off all sensations of "vibration" in my legs. After an hour I turned the unit off and had the best night's sleep in months. White noise (iPhone app) helps immensely too.

Re: TENS stimulation for WED/RLS: Effective parameters

Posted: Thu Oct 30, 2014 7:13 pm
by Polar Bear
I personally never found the TENS to be of a great benefit but your placement is interesting and I'm glad to give it a try.
Now.... I wonder if my adhesive pads are still 'adhering' :) I will get sorted and give this a go.

With regard to white noise. I have this on an app and do find that it can be beneficial in getting over to sleep. Not when there are WED/RLS symptoms present, white noise wouldn't help me there, but it can help (on occasion) when it's a case of 'sleep doesn't want to come'.

Re: TENS stimulation for WED/RLS: Effective parameters

Posted: Thu Oct 30, 2014 8:11 pm
by sleepdancer2
@fixrls It's good to hear from a physical therapist on this. While I have successfully used a TENS for PLMD for 4 years I have done so with no professional instruction so it's been trial and error on placement and settings. After much error, I ended up using it as it was prescribed for low back pain. What I've never known is when using the electrodes on the lower back, if the proper way is to have the red and black at the same level on either side of the back, or horizontally on the same side. Or if both are wrong. Do you have a physician on board with this or is this your personal efforts? I'm guessing what would work for RLS/WED and for PLMD would be different. Feel like I'm on an island with this.

Re: TENS stimulation for WED/RLS: Effective parameters

Posted: Fri Oct 31, 2014 4:32 am
by fixrls
@polarbear,
As a DPT in the US, I research everything thoroughly on medical databases. The reason white noise is helpful is because this sensory input theoretically can strengthen neural circuits as well as sensory perceptual areas of the cerebral cortex. Using sound to "shut off" the false sensations my brain is interpreting as leg stuff (vibration, creepy-crawlies, etc.), I have trained my brain to ignore them. When I am at conferences (lots of air travel and sitting in lecture halls), nights are hell, but keeping the hotel room TV on at barely audible levels, news channels with very little pitch modulation, allows me to sleep fairly well in the dreaded hotel room. I am very interested in conducting research on use of low-intensity sensory stimulation (tactile such as TENS, auditory such as white noise) which taps into non-pharmaceutical improvement of RLS sensations, and I hope to learn as much as possible from others with this condition .
@sleepdancer2: In Colorado, US, physical therapists routinely treat patients with a wide range of orthopedic and neurological conditions without physician referral/oversight as long as evaluation and treatment complies with our state practice act. Our training includes extensive education in neurological systems, and we use "physical" modalities to effect them. There is some good evidence regarding the use of TENS, and although it is a bit of a hassle, I choose to treat myself with this modality rather than use medications. So far the results are good for shutting off my leg symptoms long enough to fall asleep and stay asleep. I am going to start a log and track duration of sleep, reduction of sensations, and alertness during the day.

Re: TENS stimulation for WED/RLS: Effective parameters

Posted: Fri Nov 07, 2014 4:40 pm
by chuas2
What if you have WED in an arm (which I do). I tried placing the pads around my upper arm, but they seemed to aggravate the symptoms. Maybe it's one of those things where they have to be placed on your back to help your arms? No idea. Anyone tried this?

Re: TENS stimulation for WED/RLS: Effective parameters

Posted: Sat Nov 08, 2014 3:40 am
by ViewsAskew
chuas2 wrote:What if you have WED in an arm (which I do). I tried placing the pads around my upper arm, but they seemed to aggravate the symptoms. Maybe it's one of those things where they have to be placed on your back to help your arms? No idea. Anyone tried this?


I have not tried it, but so far, TENS has not helped WED/RLS in my legs, so could be it just does not work for everyone.

Re: TENS stimulation for WED/RLS: Effective parameters

Posted: Sat Nov 08, 2014 8:30 am
by badnights
I tried it again last night, since I was feeling symptoms despite medication. I put the positive leads on back of calf and negative on front of thigh (as a previous post suggests). There was a flare of strong WED in response, but I psyched it down and kept the unit going for 45 minutes. I was tensed in froggie position trying to sleep, bouncing between Stage 1 and awake.

After I shut the TENS off, for some reason I decided to turn it on again, and exact same thing happened, it made the WED flare instantly.

So I will give up on TENS for WED until maybe two or three years from now when someone else's success story will overcome my own memories and I'll give it another go :)

Re: TENS stimulation for WED/RLS: Effective parameters

Posted: Sat Nov 08, 2014 1:43 pm
by cornelia
Personally I think that TENS can work for some RLS patients. I always think that when dr B doesn't recommend it often (almost never) in his Q&A pages it probably will not work for most of us. Maybe silly to think like that but I really do.

Corrie

Re: TENS stimulation for WED/RLS: Effective parameters

Posted: Sat Nov 08, 2014 9:51 pm
by ViewsAskew
badnights wrote:I tried it again last night, since I was feeling symptoms despite medication. I put the positive leads on back of calf and negative on front of thigh (as a previous post suggests). There was a flare of strong WED in response, but I psyched it down and kept the unit going for 45 minutes. I was tensed in froggie position trying to sleep, bouncing between Stage 1 and awake.

After I shut the TENS off, for some reason I decided to turn it on again, and exact same thing happened, it made the WED flare instantly.

So I will give up on TENS for WED until maybe two or three years from now when someone else's success story will overcome my own memories and I'll give it another go :)


That is my response, also. Interestingly, you and I seem to respond VERY similarly to most things. This, again, makes me wonder about variants of the disease AND if some of us may actually have something very different, but with similar enough attributes that we do not yet realize they are different. For example, could there be a type of neuropathy that is yet undefined that is so close to WED that we think they are the same?

Re: TENS stimulation for WED/RLS: Effective parameters

Posted: Sun Nov 09, 2014 2:39 am
by badnights
I was JUST thinking that as I read over Phillipsxxx'd posts about the CP Relief Wand. She seems to have something very similar to what you and I have, but not quite the same, and I was wondering if some day people would realize it was a variant. Then I wondered if there are two main variants discovered, which one would get to keep the WED name ?.... lol
the places the mind goes

Re: TENS stimulation for WED/RLS: Effective parameters

Posted: Sun Nov 09, 2014 8:22 am
by sleepdancer2
When I first tried using the TENS I tried just about every variation of leg and foot placement and it was like torture during my experimentation phase. Once I started using the electrodes on my lower back was the first I found relief. Has anyone else here tried using them on the lower back?

Re: TENS stimulation for WED/RLS: Effective parameters

Posted: Sun Nov 09, 2014 9:20 am
by ViewsAskew
sleepdancer2 wrote:When I first tried using the TENS I tried just about every variation of leg and foot placement and it was like torture during my experimentation phase. Once I started using the electrodes on my lower back was the first I found relief. Has anyone else here tried using them on the lower back?

Not I.

I use it on my shoulder, neck and mid back , and buttocks/hips for trigger points. In those positions it's never had any affect on WED. I don't think I've ever used it on the lower back, though... I haven't used it in quite awhile. I'll have to try and see if it helps. So far, nothing I've tried that has helped others - from supplements to rubs to diet - has helped me. I am pretty skeptical these days, I must admit.

Re: TENS stimulation for WED/RLS: Effective parameters

Posted: Wed Nov 12, 2014 11:42 am
by badnights
I've used them in a criss-cross on my lower back for sciatica (positive higher on one side, lower on the other, all four on the lower back), and it works OK for that. I use it on my shoulders for seized muscles, works very well for that. Neither placement does anything for the WED in arms or legs, though.